The Nosology of Transgender People


The nosology associated with transgender phenomena is undergoing rapid revisions. For example, the terms cross-dresser and transvestite have fallen out of favor.

The clinical definition of transvestism is much more restricted than the colloquial use of this term. It distinguishes between fetishistic transvestism that is sexually arousing and dual role transvestism that is not.

Gender Identity

Gender identity is your internal sense of whether you are female, male, neither, or a mix of many genders. It’s different than sexual orientation, which describes a person’s enduring attraction to people of the same sex or other sexes.

If you identify as the sex assigned to you at birth — either male or female — you are called cisgender. You may also identify as transgender, agender, Two-Spirit, nonbinary, genderqueer or intersex.

A transvestite is someone who dresses in clothing that differs from the sex assigned at birth for self-expression, personal pleasure, or both. This may include cross dressers, drag queens or kings, and other people who may exhibit components of a transgender identity. Historically, this term has been more clinical and used to describe individuals who sought medical intervention (hormones or surgery) for gender affirmation. Today, this term has become more inclusive and less pejorative. It can be shortened to transsexual, but some people prefer the more inclusive terms of transgender or gender nonconforming.

Gender Expression

Gender expression is how you show your gender publicly, such as through clothing, hairstyles and behaviour. It can also include the name you choose and how others refer to you, as well as your body language.

Your gender expression can differ from your internal gender identity, but they are not the same thing. People who are transgender often have a different gender expression than the one they were assigned at birth, and this is okay.

Many transgender individuals use gender-affirming care, which includes treatments or procedures that align their physical features with their gender identity. This may include chest binders, voice therapy or surgery to modify genitalia or body hair.

The LGBTQ2S+ acronym stands for lesbian, gay, bisexual (or bi), transgender, queer or questioning, and two-spirit people. It’s an inclusive term that reflects the diversity of sexual orientations and gender identities.

Gender Differences

People who dress in clothing that differs from their sex at birth are referred to as transgender. While it may be confusing, the terms transgender and transvestite are not synonymous.

Transvestite is a word that should not be used to describe someone who performs in drag. Drag queens are typically women who wear feminine clothing and act as a woman, while drag kings are men who wear masculine clothing and perform male sexual acts.

People who engage in transvestism as part of a lifestyle usually keep their activities private and are not distressed by their behavior. However, there is a condition known as transvestic fetishism, which involves a person wearing clothing that is associated with erotic fantasies and causes distress or interferes with work and social life.

Some transvestites are able to seek help for their condition through counseling and other support groups. Others are referred to psychologists for treatment. The LGBT community has been vocal about the need to address these problems and is hopeful that societal attitudes will change.

Gender Stigma

Gender stigma can manifest as prejudice, rejection and discrimination. It can take a variety of forms: lawmakers who use anti-transgender rhetoric to score cheap political points; family, friends or coworkers who reject trans people because of their gender identity or expression; and strangers who harass, bully or commit serious violence against trans individuals.

Stigma can lead to stress, which can have adverse health consequences. Interventions designed to reduce stigma among transgender and gender-diverse people accessing healthcare should be multi-level, addressing stigma at the individual (e.g., stigma management and coping), interpersonal (e.g., healthcare provider attitudes) and structural (e.g., policies that impede access to gender affirming healthcare) levels.

In the Thai context, biological sex, gender and sexuality are often conflated, and the term “people of diverse gender” can be used to refer to all SGM. However, this is a misrepresentation of the situation and may lead to stigma and misunderstandings. Future research should clearly distinguish between the terms sex, gender and sexual orientation.